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造血干细胞移植治疗多发性硬化症的可行性及毒性

Feasibility and toxicity of hematopoietic stem cell transplant in multiple sclerosis.

作者信息

Kuan Thomas Low Tat, Amini Farahnaz, Seghayat Marjan Sadat

机构信息

School of Healthy Aging, Medical Aesthetics and Regenerative Medicine, Faculty of Medicine and Health Science, UCSI University, Kuala Lumpur, Malaysia.

出版信息

Iran J Basic Med Sci. 2017 Jul;20(7):729-738. doi: 10.22038/IJBMS.2017.9000.

Abstract

Multiple sclerosis is a debilitating disease of the central nervous system. It affects people of all ages but is more prevalent among 20-40 year olds. Patients with MS can be presented with potentially any neurological symptom depending on the location of the lesion. A quarter of patients with MS suffer from bilateral lower limb spasticity among other symptoms. These devastating effects can be detrimental to the patient's quality of life. Hematopoietic stem cells (HSCs) have been used as a treatment for MS over the past 2 decades but their safety and efficacy has are undetermined. The objective of this study is to evaluate the feasibility and toxicity of autologous HSCs transplantation in MS. A literature search was done from 1997 to 2016 using different keywords. A total of 9 articles, which met the inclusion and exclusion criteria, were included in this review. The type of conditioning regimen and technique of stem cell mobilization are summarized and compared in this study. All studies reported high-dose immunosuppressive therapy with autologous HSCs transplantation being an effective treatment option for severe cases of multiple sclerosis. Fever, sepsis, and immunosuppression side effects were the most observed adverse effects that were reported in the selected studies. HSCs is a feasible treatment for patients with MS; nevertheless the safety is still a concern due to chemo toxicity.

摘要

多发性硬化症是一种使中枢神经系统衰弱的疾病。它影响所有年龄段的人,但在20至40岁的人群中更为普遍。根据病变部位的不同,多发性硬化症患者可能会出现任何潜在的神经症状。四分之一的多发性硬化症患者除了其他症状外,还患有双侧下肢痉挛。这些破坏性影响会对患者的生活质量产生不利影响。在过去20年中,造血干细胞(HSCs)已被用作治疗多发性硬化症的方法,但其安全性和有效性尚未确定。本研究的目的是评估自体造血干细胞移植治疗多发性硬化症的可行性和毒性。使用不同关键词对1997年至2016年的文献进行了检索。本综述共纳入9篇符合纳入和排除标准的文章。本研究对预处理方案的类型和干细胞动员技术进行了总结和比较。所有研究均报告,高剂量免疫抑制疗法联合自体造血干细胞移植是治疗重症多发性硬化症的有效选择。发热、败血症和免疫抑制副作用是所选研究中最常观察到的不良反应。造血干细胞对多发性硬化症患者是一种可行的治疗方法;然而,由于化学毒性,安全性仍然令人担忧。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/bb30/5569597/d624326de622/IJBMS-20-729-g001.jpg

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